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Proportion, Predictors and Outcomes of Delirium at a Tertiary care Hospital in Karachi, Pakistan

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Abstract

Delirium is seen in about one third of all sick elderly patients. As elderly inpatient admissions increase in our setting, it becomes important to understand the risk factors and predictors of delirium to better manage and prevent this disorder. A retrospective analysis of medical records of all patients 65 years and older admitted in 2009 at the Aga Khan University Hospital, Karachi was performed. A pretested questionnaire was designed to obtain information on patient demographics, diagnoses, medication usage, hospital course, and complications. All patients that had a diagnosis or sub-diagnosis of delirium were reviewed for associated factors, causes, and outcomes. Data were compared between patients with and without delirium for associated factors, and outcomes. Multivariable logistic regression was performed and crude and adjusted odds ratio with 95 % confidence interval was calculated. A total of 464 charts were reviewed and 22 % were found to have delirium. Infection was the most common cause of delirium. Increasing age (AOR 1.9), prior neurological disorder (AOR 2.2), pneumonia (AOR 3.3) and urinary tract infection (AOR 3.1), psychoactive drug use (AOR 2.1), and poor functionality (AOR 5.75) were strongly associated with an increased risk of delirium. Delirium was associated with higher length of stay, and medical complication rate and increased mortality. This was a baseline study that confirmed the commonly known risk factors for delirium. Of most concern was poor functional status and psychoactive drug use in the overall patient sample. It highlighted the need for using appropriate and timely diagnostic tests to identify delirium in our elderly inpatients.

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References

  • Adamis, D., Treloar, A., Martin, F. C., & Macdonald, A. J. (2006). Recovery and outcome of delirium in elderly medical inpatients. Archives of Gerontology and Geriatrics, 43(2), 289–298.

    Article  Google Scholar 

  • Adunsky, A., Levy, R., Heim, M., Mizrahi, E., & Arad, M. (2003). The unfavorable nature of preoperative delirium in elderly hip fractured patients. Archives of Gerontology and Geriatrics, 36(1), 67–74.

    Article  Google Scholar 

  • Balas, M. C., Happ, M. B., Yang, W., Chelluri, L., & Richmond, T. (2009). Outcomes associated with delirium in older patients in surgical ICUs. Chest, 135(1), 18–25.

    Article  Google Scholar 

  • Berkemeyer, S., Schumacher, J., Thiem, U., & Pientka, L. (2009). Bone T-scores and functional status: a cross-sectional study on German elderly. PloS One, 4(12), e8216.

    Article  Google Scholar 

  • British Geriatric Society. (2006). Guidelines for prevention, diagnosis and management of delirium in older people in hospital. (Jan 2006).

  • Choon, C. N., Shein, S. L., & Chan, A. (2008). Feminization of Ageing and Long term Financing in Singapore. Available at http://www.fas.nus.edu.sg/ecs/pub/wp-scape/0806.pdf.

  • Chrispal, A., Mathews, K. P., & Surekha, V. (2010). The clinical profile and association of delirium in geriatric patients with hip fractures in a tertiary care hospital in India. Journal of the Association of Physicians India, 58, 15-19.

    Google Scholar 

  • Clegg, A., & Young, J. B. (2011). Which medications to avoid in people at risk of delirium: a systematic review. Age and Ageing, 40(1), 23–29.

    Article  Google Scholar 

  • Cole, M. G., Ciampi, A., Belzile, E., & Zhong, L. (2009). Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age and Ageing, 38(1), 19–26.

    Article  Google Scholar 

  • Elie, M., Cole, M. G., Primeau, F. J., & Bellavance, F. (1998). Delirium risk factors in elderly hospitalized patients. Journal of General Internal Medicine, 13(3), 204–212.

    Article  Google Scholar 

  • Fong, T. G., Tulebaev, S. R., & Inouye, S. K. (2009). Delirium in elderly adults: diagnosis, prevention and treatment. Nature Reviews Neurology, 5(4), 210–220.

    Article  Google Scholar 

  • George, J., Bleasdale, S., & Singleton, S. J. (1997). Causes and prognosis of delirium in elderly patients admitted to a district general hospital. Age and Ageing, 26(6), 423–427.

    Article  Google Scholar 

  • Guntena, A. V., & Mosimannb, U. P. (2010). Delirium upon admission to Swiss nursing homes: a cross-sectional study. Swiss Medical Weekly, 140(25–26), 376–381.

    Google Scholar 

  • Habiba, U., Ahmad, S., & Hassan, L. (2002). Predisposition to osteoporosis in postmenopausal women. Journal of the College of Physicians and Surgeons-Pakistan, 12, 297–301.

    Google Scholar 

  • Han, J. H., Zimmerman, E. E., Cutler, N., Schnelle, J., Morandi, A., Dittus, R. S., et al. (2009). Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Academic Emergency Medicine, 16(3), 193–200.

    Article  Google Scholar 

  • Hempenius, L., van Leeuwen, B. L., van Asselt, D. Z., Hoekstra, H. J., Wiggers, T., Slaets, J. P., et al. (2011). Structured analyses of interventions to prevent delirium. International Journal of Geriatric Psychiatry, 26(5), 441–450.

    Article  Google Scholar 

  • Inouye, S. K. (2006). Delirium in older persons. The New England Journal of Medicine, 354(11), 1157–1165.

    Article  Google Scholar 

  • Inouye, S. K., & Charpentier, P. A. (1996). Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. Journal of the American Medical Association, 275(11), 852–857.

    Article  Google Scholar 

  • Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113(12), 941–948.

    Article  Google Scholar 

  • Inouye, S. K., Foreman, M. D., Mion, L. C., Katz, K. H., & Cooney, L. M., Jr. (2001). Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Archives of Internal Medicine, 161(20), 2467–2473.

    Article  Google Scholar 

  • Kakuma, R., du Fort, G. G., Arsenault, L., Perrault, A., Platt, R. W., Monette, J., et al. (2003). Delirium in older emergency department patients discharged home: effect on survival. Journal of American Geriatrics Society, 51(4), 443–450.

    Article  Google Scholar 

  • Khurana, V., Gambhir, I. S., & Kishore, D. (2011). Evaluation of delirium in elderly: a hospital-based study. Geriatrics and Gerontology International.

  • Khuwaja, A. K., Ali, N. S., & Zafar, A. M. (2007). Use of psychoactive drugs among patients visiting outpatient clinics in Karachi, Pakistan. Singapore Medical Journal, 48(6), 509–513.

    Google Scholar 

  • Korevaar, J. C., van Munster, B. C., & de Rooij, S. E. (2005). Risk factors for delirium in acutely admitted elderly patients: a prospective cohort study. BMC Geriatrics, 5, 6.

    Article  Google Scholar 

  • Laurila, J. V., Laakkonen, M. L., Tilvis, R. S., & Pitkala, K. H. (2008). Predisposing and precipitating factors for delirium in a frail geriatric population. Journal of Psychosomatic Research, 65(3), 249–254.

    Article  Google Scholar 

  • Levkoff, S. E., Evans, D. A., Liptzin, B., Cleary, P. D., Lipsitz, L. A., Wetle, T. T., et al. (1992). Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Archives of Internal Medicine, 152(2), 334–340.

    Article  Google Scholar 

  • Litaker, D., Locala, J., Franco, K., Bronson, D. L., & Tannous, Z. (2001). Preoperative risk factors for postoperative delirium. General Hospital Psychiatry, 23(2), 84–89.

    Article  Google Scholar 

  • Mattoo, S. K., Grover, S., & Gupta, N. (2010). Delirium in general practice. Indian Journal of Medical Research, 131, 387–398.

    Google Scholar 

  • Miller, M. O. (2008). Evaluation and management of delirium in hospitalized older patients. American Family Physician, 78(11), 1265–1270.

    Google Scholar 

  • Mittal, V., Muralee, S., Williamson, D., McEnerney, N., Thomas, J., Cash, M., et al. (2010). Review: delirium in the elderly: a comprehensive review. American Journal Alzheimer’s Disease Other Dementia, 26(2), 97–109.

    Google Scholar 

  • Monette, J., Galbaud du Fort, G., Fung, S. H., Massoud, F., Moride, Y., Arsenault, L., et al. (2001). Evaluation of the Confusion Assessment Method (CAM) as a screening tool for delirium in the emergency room. General Hospital Psychiatry, 23(1), 20–25.

    Article  Google Scholar 

  • National Health Statistics Report. (2007). National Hospital Discharge Survey. Available at http://www.cdc.gov/nchs/data/nhsr/nhsr029.pdf.

  • Nishtar, S. (2007). Health Indicators of Pakistan—Gateway Paper II. Islamabad, Pakistan: Heartfile. Available at: www.heartfile.org/pdf/GWP-II.pdf.

  • O’Keeffe, S., & Lavan, J. (1997). The prognostic significance of delirium in older hospital patients. Journal of American Geriatrics Society, 45(2), 174–178.

    Google Scholar 

  • O’Mahony, R., Murthy, L., Akunne, A., & Young, J. (2011). Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium. Annals of Internal Medicine, 154(11), 746–751.

    Google Scholar 

  • Sandberg, O., Gustafson, Y., Brannstrom, B., & Bucht, G. (1999). Clinical profile of delirium in older patients. Journal of American Geriatrics Society, 47(11), 1300–1306.

    Google Scholar 

  • Saxena, S., & Lawley, D. (2009). Delirium in the elderly: a clinical review. Postgraduate Medical Journal, 85(1006), 405–413.

    Article  Google Scholar 

  • Schor, J. D., Levkoff, S. E., Lipsitz, L. A., Reilly, C. H., Cleary, P. D., Rowe, J. W., et al. (1992). Risk factors for delirium in hospitalized elderly. Journal of the American Medical Association, 267(6), 827–831.

    Article  Google Scholar 

  • Siddiqi, N., House, A. O., & Holmes, J. D. (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age and Ageing, 35(4), 350–364.

    Article  Google Scholar 

  • Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P., & van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Jama, 304(4), 443–451.

    Google Scholar 

  • Wong, C. L., Holroyd-Leduc, J., Simel, D. L., & Straus, S. E. (2010). Does this patient have delirium?: value of bedside instruments. Jama, 304(7), 779–786.

    Google Scholar 

  • World Health Organization. (2011). Noncommunicable country profiles 2011. Available at http://www.who.int/nmh/countries/pak_en.pdf.

  • Young, J., & Inouye, S. K. (2007). Delirium in older people. BMJ, 334(7598), 842–846.

    Article  Google Scholar 

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Authors and Affiliations

  1. American Board Family Practice, Aga Khan University, Karachi, Pakistan

    Saniya Sabzwari

  2. Department of Family Medicine, Aga Khan University, Karachi, Pakistan

    Dileep Kumar

  3. College of Physicians Surgeons, Aga Khan University, Karachi, Pakistan

    Seema Bhanji

  4. American Board of Neurology and Psychiatry, Department of Internal Medicine, Aga Khan University, Karachi, Pakistan

    Mughis Sheerani

  5. Geriatric Research Training Program, Cardiovascular Aging Research, Reynolds Department of Geriatrics and Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, USA

    Gohar Azhar

Authors
  1. Saniya Sabzwari
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  2. Dileep Kumar
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  3. Seema Bhanji
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  4. Mughis Sheerani
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  5. Gohar Azhar
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Correspondence to Saniya Sabzwari.

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Sabzwari, S., Kumar, D., Bhanji, S. et al. Proportion, Predictors and Outcomes of Delirium at a Tertiary care Hospital in Karachi, Pakistan. Ageing Int 39, 33–45 (2014). https://doi.org/10.1007/s12126-012-9152-5

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  • DOI: https://doi.org/10.1007/s12126-012-9152-5

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